Polycystic ovary syndrome (PCOS) is far more than just a reproductive issue; it is a chronic, multisystem condition with endocrine, metabolic, and psychological consequences that can span a lifetime. Despite affecting an estimated 8–13% of women of reproductive age, it remains a clinical enigma for many, with up to 70% of cases going undiagnosed.
As a doctor, you know that the “textbook” presentation of PCOS is rarely what walks into your surgery. The heterogeneity of the condition, ranging from irregular cycles and infertility to metabolic dysfunction and severe distress over dermatological symptoms, makes early identification both a challenge and a necessity.
Diagnosing PCOS
The Rotterdam criteria are the most widely accepted way to diagnose PCOS in the UK and globally. Because it is a diagnosis of exclusion, we look for adults to meet two out of the following three criteria (once other potential causes are ruled out):
- Ovulatory dysfunction: This presents as irregular menstrual cycles — for example, cycles lasting more than 35 days or less than 21 days, or having fewer than eight cycles per year.
- Hyperandrogenism: This can be clinical, such as acne, hirsutism, and alopecia, or it can be biochemical.
- Polycystic ovarian morphology (PCOM): This is identified via an ultrasound scan.
One of the most useful things to remember in a clinic is if your patient already presents with both irregular cycles and hyperandrogenism, an ovarian ultrasound is not actually required to confirm the diagnosis.
A Holistic Approach
Managing PCOS requires looking past the immediate symptoms to the long-term risks. Women with PCOS are two to three times more likely to experience depression and anxiety, and many face a higher risk of Type 2 diabetes, cardiovascular disease, and endometrial hyperplasia.
While pharmacological treatments like combined hormonal contraceptives or anti-androgens are often used, lifestyle interventions remain the cornerstone of care. Tailoring these strategies to the individual —considering their specific goals, whether it’s fertility, weight management, or skin concerns — is key to improving quality of life.
Enhance Your Clinical Practice
Ready to refine your approach to PCOS? We’ve developed a 30-minute accredited CPD course specifically for BMA members practicing in the UK.
This course uses a case-based approach to explore the clinical presentation, diagnostic criteria, and current best practices in managing PCOS. It will focus on:
- Recognising the diverse clinical features and the impact of PCOS on fertility.
- Applying the latest diagnostic criteria accurately in your daily practice.
- Implementing evidence-based management, from lifestyle changes to pharmacological treatments.
Access the accredited course here.